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Predicting cholecystocholedochal fistulas in patients with Mirizzi syndrome undergoing endoscopic retrograde cholangiopancreatography

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World Journal of Gastroenterology 2020年第40期26卷 6241-6249页

作者： Chi-Huan Wu Nai-Jen Liu Chun-Nan Yeh Shang-Yu Wang yi-yin jan Department of Gastroenterology and Hepatology Linkou Medical CenterChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineTaoyuan 333Taiwan Department of General Surgery Linkou Medical CenterChang Gung Memorial HospitalChang Gung UniversityCollege of MedicineTaoyuan 333Taiwan

BACKGROUND Mirizzi syndrome(MS) is defined as an extrinsic compression of the extrahepatic biliary system by an impacted stone in the gallbladder or the cystic duct leading to obstructive jaundice. Endoscopic retrograde cholangiopancreatography(ERCP) could serve diagnostic and therapeutic purposes in patients with MS in addition to revealing the relationships between the cystic duct, the gallbladder, and the common bile duct(CBD). Cholecystectomy is a challenging procedure for a laparoscopic surgeon in patients with MS, and the presence of a cholecystocholedochal fistula renders preoperative diagnosis important during *** To evaluate cholecystocholedochal fistulas in patients with MS during ERCP before *** From 2004 to 2018, all patients diagnosed with MS during ERCP were enrolled in this study. Patients with associated malignancy or those who had already undergone cholecystectomy before ERCP were excluded. In total, 117 patients with MS diagnosed by ERCP were enrolled in this study. Among them, 21 patients with MS had cholecystocholedochal fistulas. MS was further confirmed during cholecystectomy to check if cholecystocholedochal fistulas were present. The clinical data, cholangiography, and endoscopic findings during ERCP were recorded and *** Gallbladder opacification on cholangiography is more frequent in patients with MS complicated by cholecystocholedochal fistulas(P < 0.001). Pus in the CBD and stricture length of the CBD longer than 2 cm were two additional independent factors associated with MS, as demonstrated by multivariate analysis(odds ratio 5.82, P = 0.002;0.12, P = 0.008, respectively).CONCLUSION Gall bladder opacification is commonly seen in patients with MS with cholecystocholedochal fistulas during pre-operative ERCP. Additional findings such as pus in the CBD and stricture length of the CBD longer than 2 cm may aid the diagnosis of MS with cholecystocholedochal fistulas.

关键词： Cholecystectomy Cholecystocholedochal fistula Common bile duct Endoscopic retrograde cholangiopancreatography Mirizzi syndrome

Successful laparoscopic management for cholecystoenteric fistula

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World Journal of Gastroenterology 2006年第5期12卷 772-775页

作者： Chun-Nan Yeh yi-yin jan Department of General Surgery Chang Gung Memorial HospitalChang Gung UniversityTaiwanChina

AIM： Since 1987, laparoscopic cholecystectomy （LC） has been widely used as the favored treatment for gallbladder lesions. Cholecystoenteric fistula （CF） is an uncommon complication of the gallbladder disease, which has been one of the reasons for the conversion from LC to open cholecystectomy. Here, we have reported four cases of CF managed successfully by laparoscopic approach without conversion to open cholecystectomy. METHODS： During the 4-year period from 2000 to 2004, the medical records of the four patients with CF treated successfully with laparoscopic management at the Chang Gung Memorial HospitaI-Taipei were retrospectively reviewed. RESULTS： The study comprised two male and two female patients with ages ranging from 36 to 74 years （median： 53.5 years）. All the four patients had right upper quadrant pain. Two of the four patients were detected with pneumobilia by abdominal ultrasonography. One patient was diagnosed with cholecystocolic fistula preoperatively correctly by endoscopic retrograde cholangiopancreatography and the other one was diagnosed as cholecystoduodenal fistula by magnetic resonance cholangiopancreatography. Correct preoperative diagnosis of CF was made in two of the four patients with 50% preoperative diagnostic rate. All the four patients underwent LC and closure of the fistula was carried out by using Endo-GIA successfully with uneventful postoperative courses. The hospital stay of the four patients ranged from 7 to 10 d （median, 8 d）. CONCLUSION： CF is a known complication of chronic gallbladder disease that is traditionally considered as a contraindication to LC. Correct preoperative diagnosis of CF demands high index of suspicion and determines the success of laparoscopic management for the subset of patients. The difficult laparoscopic repair is safe and effective in the experienced hands of laparoscopic surgeons.

关键词： Laparoscopic management Cholecystoenteric fistula

Actinomycosis mimicking recurrent carcinoma after Whipple's operation

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World Journal of Gastroenterology 2005年第11期11卷 1722-1724页

作者： Jun-Te Hsu Hung-Chieh Lo yi-yin jan Department of General Surgery

Actinomycosis is a rare, chronic, spreading, suppurative,granulomatous and fibrosing infection. Actinomyces are normal inhabitants of the oral cavity and gastrointestinal tract. They rarely cause disease and are seldom reported as pathogens. Herein, we reported on a 69-year-old male patient who had undergone Whipple's operation due to ampulla Vater carcinoma, and became infected with actinomycosis at the pancreaticojejunostomy, which mimicked a recurrent malignancy. He was treated with radical resection of the mass at the pancreaticojejunostomy and had an uneventful postoperative course.

关键词： Actinomycosis Carcinoma Pancreaticojejunostomy Recurrent Whipple

Prognostic analysis of surgical treatment of peripheral cholangiocarcinoma: Two decades of experience at Chang Gung Memorial Hospital

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World Journal of Gastroenterology 2005年第12期11卷 1779-1784页

作者： yi-yin jan Chun-Nan Yeh Ta-Sen Yeh Tse-Ching Chen Department of Surgery Department of Pathology

AIM: To analyze the prognostic factors influencing the overall survival of peripheral cholangiocarcinoma (PCC) patients undergoing surgical treatment during 25 years at a single institution. METHODS: This study retrospectively reviewed prospectively collecting data about 373 patients with historically proven PCC who underwent surgical treatment between 1977 and 2001. RESULTS: Three hundred and seventy-three PCC patients (159 men and 214 women) underwent surgical treatment from 1977 to 2001. Among them, 187 PCC patients underwent hepatectomy and 135 had curative resection (curative resectability rate: 36.2%). The follow-up duration ranged from 1.05 to 167.6 mo (mean/median = 14.1/7.2 mo). Overall cumulative survival rates at 1, 3, and 5 years were 32.5%, 9.2%, and 4.1%, respectively. Univariate log-rank analysis identified the following as adverse influences on overall survival: presence of symptoms, absence of mucobilia, elevated CEA and CA 19-9 levels, non-papillary tumor type, receiving non-hepatectomy, advanced tumor staging, lack of post-operative chemotherapy, and radiotherapy. Meanwhile, multivariate Cox's proportional hazard analysis demonstrated that absence of mucobilia, non-papillary tumor type, advanced tumor staging, non-hepatectomy, and lack of post-operative chemotherapy were the five independent prognostic factors that adversely affected overall survival. CONCLUSION: Favorable overall survival of PCC patients undergoing surgical treatment depends on early tumor stage, presence of mucobilia, papillary tumor type, hepatic resection, and post-operative chemotherapy.

关键词： Prognostic factor Surgical treatment Peripheral cholangiocarcinoma

Treatment of patients with advanced gastrointestinal stromal tumor of small bowel: Implications of imatinib mesylate

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World Journal of Gastroenterology 2006年第23期12卷 3760-3765页

作者： Chun-Nan Yeh Tsung-Wen Chen Ting-Jung Wu Swei Hsueh yi-yin jan Department of Surgery Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwanChina Department of Pathology Chang Gung Memorial HospitalChang Gung University5 Fu-Hsing StreetKwei-ShanTaoyuanTaiwan China

AIM： To examine the impact of imatinib mesylate （Glivec） on patient survival and response and its safety, and the correlation of the response rate with the kit gene mutation status. METHODS： Thirty-three of 74 （44.6%） small bowel gastrointestinal stromal tumor （GIST） patients who developed recurrence after curative resection and not treated with Glivec were classified as group A patients. Twenty-two advanced small bowel GIST patients treated with Glivec were classified as group B patients. Clinicopathological features, post-recurrence and overall survival rates were compared. Each tumor in group B patients was investigated for mutations of kit or plateletderived growth factor alpha （PDGFRA）. The mutation type was correlated with clinical outcomes. The antitumor effect and safety of Glivec in group B patients were also assessed. RESULTS： Advanced small bowel GIST patients treated with Glivec had substatntially longer post-recurrence survival and higher overall survival rates than those not treated with Glivec. A total of 15 patients had a partial response （PR）（67.8%）. Activated mutations of c-kit were found in 16 of 19 tested patients and no PDGFRA mutant was identified. In 13 patients with GISTs harboring exon 11 kit mutations, the partial response rate （PR） was 69.3%, whereas two of three patients with tumors containing an exon 9 kit mutation had an overall response rate （ORR） of 66.7% （not significant）. CONCLUSION： Glivec significantly prolongs the postrecurrence and overall survival of Asian patients with advanced GISTs. Glivec induces a sustained objective response in more than half of Asian patients withadvanced small bowel GISTs. Activated mutations of kit exon 11 are detectable in the vast majority of GISTs. There is no difference in the PR rate for patients whose GISTs have kit exon 9 and exon 11 mutations.

关键词： Gastrointestinal stromal tumor Glivec Patient survival Kit gene mutation

Primary squamous cell carcinoma of the liver:A successful surgically treated case

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World Journal of Gastroenterology 2006年第33期12卷 5419-5421页

作者： Hsiang-Lin Lee Yu-yin Liu Chun-Nan Yeh Kun-Chun Chiang Tse-Ching Chen yi-yin jan Department of Surgery Chang Gung Memorial Hospital Chang Gung University Taiwan China Department of Pathology Chang Gung Memorial Hospital Chang Gung University Taiwan China

Primary squamous cell carcinoma (SCC) of the liveris rare. Totally nine such cases have been reportedin the literature. Primary SCC of the liver has beenreported to be associated with hepatic teratoma,hepatic cyst, or hepatolithiasis. Complete remission ofpoorly differentiated SCC of the liver could be achievedby systemic chemotherapy followed by surgery orremarkably respond to hepatic arterial injection of lowdose chemotherapeutic drugs. Here we report the fi rstcase of primary SCC of the liver presenting as a solidtumor and receiving successful hepatic resection with9-mo disease free survival.

关键词： Squamous cell carcinoma Liver Surgery

Correct diagnosis and successful treatment for pericardial effusion due to toothpick injury: A case report and literature review

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World Journal of Gastroenterology 2007年第31期13卷 4278-4281页

作者： Yu-yin Liu Chun-Nan Yeh Hsiang-Lin Lee yi-yin jan Jeng-Hwei Tseng Ji-Tseng Fang Department of Surgery Chang Gung Memorial Hospital ChangGung University Taiwan China Department of Radiology Chang GungMemorial Hospital Chang Gung University Taiwan China Department of Internal Medicine Chang GungMemorial Hospital Chang Gung University Taiwan China

We reported a 55-year-old man who suffered from chest pain and dyspnea on exertion for two weeks associated with night sweating, general malaise, poor appetite, and body weight loss. Physical examination revealed friction rub with distant heart sound, bilateral clear breathing sound, no abdomen tenderness, and normal bowel sound. Subsequent chest X-ray revealed cardiomegaly and cardiac echo showed massive pericardial and pleural effusion with normal left ventricular function. Constrictive pericarditis was diagnosed based on clinical information. Tuberculosis (TB), malignancy, autoimmune disease, infection, hypothyroidism, and idiopathic could be the causes but excluded by further study. High-resolution lung CT scan after reconstruction revealed a moderate amount pericardial effusion with possible superimposed infection. Thickness of pericardium and left lobe liver abscess were found. A straight tubular structure about 6 cm in length transverses the lateral segment of liver to pericardial space and unknown foreign body was suspected. Laparotomy was performed, 6.5 cm toothpick was found through the liver into pericardium. Post-operative course was uneventful and he discharged one week later. The patient could not remember swallowing the toothpick before. He had no chest pain and dyspnea on exertion during a 6-mo follow-up period.

关键词： Toothpick injury Pericardial effusion Laparotomy

Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2cm undergoing resection

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World Journal of Gastroenterology 2009年第34期15卷 4305-4310页

作者： Kun-Chun Chiang Chun-Nan Yeh Wei-Chen Lee yi-yin jan Tsann-Long Hwang Pancreatic Cancer Team Department of SurgeryChang Gung Memorial Hospital Chang Gung University

AIM:To investigate the differences in clinicopathological features between patients with pancreatic cancer greater or less than 2 cm situated over the pancreatic head and the prognostic factors for survival of patients with pancreatic cancer2 cm)and 36 cases of small(S)-PAC(tumor≤2 cm).We compared the clinicopathological characteristics and prognosis of L-PAC and S-PAC *** clinicopathological characteristics of S-PAC were investigated to clarify the prognosis predictive factors of S-PAC. RESULTS:One hundred and fifty-nine PAC patients, aged 16-93 years(median,59.0 years)with a tumor at the pancreatic head undergoing intentional curative resection were *** S-PAC and L-PAC patients had similar demographic data,clinical features,and tumor markers(a similar positive rate of carcinoembryonic antigen and carbohy- drate antigen 19-9).There were also similar rates of lymph node metastasis,portal vein invasion,stage distribution,tumor differentiation,positive resection margin,surgical morbidity and mortality observedbetween the two *** a follow-up period ranging from 1.0 to 122.7 mo(median,10.9 mo), S-PAC and L-PAC patients had a similar prognosis after resection(P=0.4805).Among the S-PAC patients group,patients with higher albumin level(>3.5 g/dL) had more favorable survival than those with lower albumin levels,which was the only favorable predictive prognostic ***,early-staged(stageⅠ,Ⅱ) S-PAC patients tended to have a more favorable outcome than late-stage(stageⅢ,Ⅳ)S-PAC patients, but this was not statistically significant. CONCLUSION:S-PAC patients should not be regarded as early *** higher albumin level(>3.5 g/dL) an

关键词： Prognostic factor Pancreas Pancreatic head area Pancreatic cancer

Timing of mortality in severe acute pancreatitis:Experience from 643 patients

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World Journal of Gastroenterology 2007年第13期13卷 1966-1969页

作者： Chih-Yuan Fu Chun-Nan Yeh Jun-Te Hsu yi-yin jan Tsann- Long Hwang Department of General Surgery Chang Gung Memorial Hospital Chang Gung University 5 Fu-shin Street Kweishan Taoyuan Taiwan China

AIM: To determine the timing of mortality after onset of severe acute pancreatitis (SAP) and the course of the disease in a large series of patients. METHODS: From July 1996 to June 2005, all patients diagnosed with acute pancreatitis at Chang Gung Memorial Hospital, Taipei, Taiwan were retrospectively studied. Three thousand two hundred and fifty episodes of acute pancreatitis were recorded in 2248 patients (1431 males and 817 females; median age, 55.6 years; range, 18-97 years). Mortality was divided into two groups: early death (≤ 14 d after admission), and late death (> 14 d after admission). The clinical features of patients in these two groups were compared. RESULTS: Although the overall mortality rate of acute pancreatitis was 3.8% (123/3250), mortality rate of SAP was as high as 16.3% (105/643). Of those 105 SAP mortalities, 44 (41.9%) deaths occurred within the first 14 d after admission and 61 (58.1%) occurred after14 d. Incidence of early death did not significantly differ from that of late death. The co-morbidities did not contribute to the timing of death. Early deaths mainly resulted from multiple organ failure. Late deaths were mainly caused by secondary complication of infected necrosis. Intra- abdominal bleeding significantly caused higher mortality in late death. CONCLUSION: Approximately half (42%) of SAP deaths occur within 14 d and most were due to multiple organ failure. The late deaths of SAP were mostly due to infected necrosis.

关键词： Severe acute pancreatitis Mortality, Multipleorgan failure